Remote-Supervisor, Customer Reimbursement and Digital

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first.We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Job Duties/Responsibilities:

Team Leadership & Culture

•Lead and coach the Digital and Member Reimbursement Specialist by supporting digital member communications and reimbursement processing.

• Foster a culture of caring connections, accountability, and service excellence aligned with Alignment’s serving-heart culture.

• Set clear performance expectations tied to quality, turnaround time, productivity, compliance, and member satisfaction.

• Conduct regular coaching sessions, case reviews, and quality audits to ensure high standards of service and documentation accuracy in accordance with established criteria and policies.

• Support onboarding, training, and continuous skill development to strengthen regulatory knowledge and digital service capabilities.• Identify opportunities to improve and optimize workflows, reduce processing delays, and enhance the member experience.

• Escalate regulatory or process concerns promptly and partner with leadership to implement improvements.

Performance Management & Operational Excellence

• Monitor day-today operational performance metrics including productivity, turnaround time, quality scores, documentation accuracy, and member satisfaction to ensure meets response time and reimbursement case aging with accuracy to maintain procedural, compliance and audit readiness.

• Analyze operational trends to identify opportunities for coaching, process improvement, and efficiency gains.

• Develop and implement action plans to improve productivity, quality, and service outcomes.

• Support accurate and timely operational reporting aligned with organizational standards and compliance requirements.

• Contribute to scalable process improvements that support organizational growth and operational efficiency.

• Ensure timely responses to member inquiries while maintaining quality, empathy, and regulatory compliance.

• Monitor verbal and written communications to ensure clarity, professionalism, and alignment with brand and service standards

• Reinforce digital adoption by coaching Specialists to guide members toward efficient service channels when appropriate.

• Ensure all member interactions are accurately documented in CRM systems in accordance with organizational, CMS and regulatory requirements.

Cross-Functional Collaboration & Continuous Improvement

• Partner with Operations, Technology, Compliance, and other internal teams to resolve member issues and improve service processes.

• Participate in cross-functional discussions to enhance workflows, reduce friction points, and improve the overall member experience.

• Escalate recurring operational issues with data-backed insights and proposed solutions.

• Support continuous improvement initiatives that enhance digital service delivery and reimbursement processing efficiency.

Supervisory Responsibilities:

• Directly supervises Specialists supporting digital member communications and reimbursement processing functions. May expand to other Resolution Specialist based on operational needs.

• Responsible for hiring support, onboarding, coaching, performance management, recognition, and corrective action as needed.

• Ensures team compliance with Alignment policies, CMS regulations, and applicable laws.

• Maintains a strong culture of engagement, accountability, and professional development.

Job Requirements:

Experience:

Required:

• 5+ years of healthcare contact center, member services, or resolution experience within a managed care organization.
• Familiarity with grievances, appeals, Direct Member Reimbursements, and CMS-regulated environments.

Preferred:

• 2+ years of supervisory or team lead experience preferred.
• Experience supporting Medicare Advantage populations strongly preferred.

Education:

• Required: High School Diploma or GED

• Preferred: Bachelor’s degree in healthcare administration, business, or related field preferred.
• Equivalent combination of education and experience may be considered.

Specialized Skills & Competencies

• Working knowledge of Medicare Managed Care (Parts C and D) and CMS compliance requirements.
• Strong understanding of case management workflows and turnaround time management.
• Ability to coach for empathy, clarity, ownership, and resolution effectiveness.
• Analytical mindset with ability to identify trends and root causes using performance data.
• Excellent written and verbal communication skills, particularly in digital channels.
• Strong organizational skills with the ability to manage competing priorities.
• Ability to balance compassion with operational rigor in a fast-paced environment.
• Bilingual (English/Spanish) preferred.
• May be remote or hybrid. Requires:
  • Reliable internet connectivity
  • Ability to manage multiple concurrent projects
  • Strict adherence to HIPAA and confidentiality standards

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

1. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.